Document Detail

Comparison of transendocardial and intracoronary CD34+ cell transplantation in patients with nonischemic dilated cardiomyopathy.
MedLine Citation:
PMID:  24030420     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In an open-label blinded study, we compared intracoronary and transendocardial CD34(+) cell transplantation in patients with nonischemic dilated cardiomyopathy.
METHODS AND RESULTS: Of the 40 patients with dilated cardiomyopathy, 20 were randomized to receive intracoronary injection and 20 received transendocardial CD34(+) cell delivery. In both groups, CD34(+) cells were mobilized by filgrastim, collected via apheresis, and labeled with technetium-99m radioisotope for single-photon emission computed tomographic imaging. In the intracoronary group, cells were injected intracoronarily in the artery supplying segments of greater perfusion defect on myocardial perfusion scintigraphy. In the transendocardial group, electroanatomic mapping was used to identify viable but dysfunctional myocardium, and transendocardial cell injections were performed. Nuclear single-photon emission computed tomographic imaging for quantification of myocardial retention was performed 18 hours thereafter. At baseline, groups did not differ in age, sex, left ventricular ejection fraction, or N-terminal pro-brain natriuretic peptide levels. The number of CD34(+) cells was also comparable (105 ± 31 × 10(6) in the transendocardial group versus 103 ± 27 × 10(6) in the intracoronary group, P=0.62). At 18 hours after procedure, myocardial retention was higher in the transendocardial group (19.2 ± 4.8%) than in the intracoronary group (4.4 ± 1.2%, P<0.01). At 6 months, left ventricular ejection fraction improved more in the transendocardial group (+8.1 ± 4.3%) than in the intracoronary group (+4.2 ± 2.3%, P=0.03). The same pattern was observed for the 6-minute walk test distance (+125 ± 33 m in the transendocardial group versus +86 ± 13 m in the intracoronary group, P=0.03) and N-terminal pro-brain natriuretic peptide (-628 ± 211 versus -315 ± 133 pg/mL, P=0.04).
CONCLUSIONS: In patients with dilated cardiomyopathy, transendocardial CD34(+) cell transplantation is associated with higher myocardial retention rates and greater improvement in ventricular function, N-terminal pro-brain natriuretic peptide, and exercise capacity compared with intracoronary route.
CLINICAL TRIAL REGISTRATION URL: Unique identifier: NCT01350310.
Bojan Vrtovec; Gregor Poglajen; Luka Lezaic; Matjaz Sever; Aljaz Socan; Dragoslav Domanovic; Peter Cernelc; Guillermo Torre-Amione; François Haddad; Joseph C Wu
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation     Volume:  128     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-09-13     Completed Date:  2013-11-22     Revised Date:  2014-11-13    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  S42-9     Citation Subset:  AIM; IM    
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MeSH Terms
Antigens, CD34 / administration & dosage,  biosynthesis*
Bone Marrow Transplantation / methods*
Cardiomyopathy, Dilated / metabolism,  pathology*,  surgery*
Endocardium / pathology,  surgery*
Follow-Up Studies
Infusions, Intra-Arterial
Middle Aged
Myocardial Ischemia* / metabolism,  pathology,  surgery
Stem Cell Transplantation / methods*
Treatment Outcome
Reg. No./Substance:
0/Antigens, CD34

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